Infections after high-voltage cardiac implantable electronic device replacements

Background: Device infection is the most worrisome complication after replacement of cardiac implantable electronic devices, with the utmost risk among patients with replacement of a high-voltage device. Objective: This study sought to examine periprocedural approaches and investigate the contemporary infection rates after replacement of an implantable cardioverter-defibrillator or cardiac resynchronization therapy defibrillator device in 2 large university hospitals. Methods: All transvenous implantable cardioverter-defibrillator and cardiac resynchronization therapy defibrillator replacements (n = 298) performed in 2021-2023 at Helsinki University Hospital and Sahlgrenska University Hospital were included in this retrospective analysis. Baseline, clinical, and procedural data were extracted from electronic medical records, and the infection risk was assessed using the Prevention of Arrhythmia Device Infection Trial score. Results: During a mean follow-up of 24.6 ± 10.4 months after generator replacement, 3 procedure-related infections were documented, corresponding to an infection rate of 1.0%. All patients received procedural antibiotic prophylaxis, and an antibacterial envelope was used in 51.3% of the patients. There was no difference in the infection rate between the centers (0.95% vs 1.15%), although the use of an antimicrobial envelope was more common at Helsinki University Hospital than Sahlgrenska University Hospital (84.8% vs 44.2%) among high-risk patients (Prevention of Arrhythmia Device Infection Trial score ≥6). Conclusion: The incidence of procedure-related infections after high-voltage cardiac implantable electronic device replacement can be maintained at a low level when guideline-based infection prevention measures are rigorously applied.